Orthotopic hepatic transplantation in humans has now been carried out in 100 patients at our Center. Fourteen of these patients were treated during the previous year, and eight are still alive. Assuming that all patients reach one year, which now seems likely, the one year survival rate will be 57 percent. This represents a considerable improvement over previous years, in which the one year survival rates have averaged about 20-30 percent. Factors influencing survival have included: improved methods of biliary duct reconstruction, including the use of a Roux-en-Y jejunal limb to place the biliary tract of the homograft "outside" the mainstream gastrointestinal tract; the frequent use of transhepatic cholangiography to differentiate biliary obstruction from rejection; better recipient selection and the use of ABO incompatible donors for patients in urgent need of transplantation. Efforts during the coming year will focus upon further improvement in recipient survival by fully exploiting these policies and, hopefully, by further improvements in immunosuppression. BIBLIOGRAPHIC REFERENCES: Starzl, T.E. and Putnam, C.W.: Liver transplantation. (Annual Postgraduate Course, University of Minnesota, May 29-June 1, 1974). In Surgery of the Gastrointestinal Tract. (Najarian, J.S. and Delaney, J.P., eds.). New York, Intercontinental Medical Book Corporation. pp. 525-538, 1975; Starzl, T.E. and Putnam, C.W.: Hepatic sepsis: Generally applicable lessons learned from liver transplantation. (Annual Postgraduate Course, University of Minnesota, May 29-June 1, 1974). In Surgery of the Gastrointestinal Tract. (Najarian, J.S. and Delaney, J.P., eds.). New York, Intercontinental Medical Book Corporation, pp. 539-548, 1975.